tbuckley/cabot-search huggingface dataset:
What is the ideal mesh location for incisional hernia prevention during elective laparotomy? A network meta-analysis of randomized trials
Authors: Alberto Aiolfi, Davide Bona, Fabio Gambero, Andrea Sozzi, Gianluca Bonitta, Emanuele Rausa, Piero G. Bruni, Marta Cavalli, Giampiero Campanelli
Journal: International Journal of Surgery (2023)

Incisional hernia (IH) represents an important complication after surgery. Prophylactic mesh reinforcement (PMR) with different mesh locations [onlay (OL), retromuscular (RM), preperitoneal (PP), and intraperitoneal (IP)] has been described to possibly reduce the risk of postoperative IH. However, data reporting the 'ideal' mesh location are sparse. The aim of this study was to evaluate the optimal mesh location for IH prevention during elective laparotomy.Systematic review and network meta-analysis of randomized controlled trials (RCTs). OL, RM, PP, IP, and no mesh (NM) were compared. The primary aim was postoperative IH. Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference.Fourteen RCTs (2332 patients) were included. Overall, 1052 (45.1%) had no mesh (NM) while 1280 (54.9%) underwent PMR stratified in IP ( n =344 pts), PP ( n =52 pts), RM ( n =463 pts), and OL ( n =421 pts) placement. Follow-up ranged from 12 months to 67 months. RM (RR=0.34; 95% CrI: 0.10-0.81) and OL (RR=0.15; 95% CrI: 0.044-0.35) were associated with significantly reduced IH RR compared to NM. A tendency toward reduced IH RR was noticed for PP versus NM (RR=0.16; 95% CrI: 0.018-1.01), while no differences were found for IP versus NM (RR=0.59; 95% CrI: 0.19-1.81). Seroma, hematoma, surgical site infection, 90-day mortality, operative time and hospital length of stay were comparable among treatments.RM or OL mesh placement seems associated with reduced IH RR compared to NM. PP location appears promising; however, future studies are warranted to corroborate this preliminary indication.
“The Art of the Craft,” From <i>The Covenant of Water</i>
Authors: Abraham Verghese
Journal: JAMA (2023)

This Arts and Medicine feature excerpts a chapter from The Covenant of Water, the new novel from Abraham Verghese, which follows the lives of a family in South India over the 20th century who have a “condition” that consigns at least 1 member per generation to death by drowning.
Specific human leukocyte antigen class I genotypes predict prognosis in resected pancreatic adenocarcinoma: A retrospective cohort study
Authors: Qian Zhan, Lei Zhang, Chenlei Wen, Ying Yang, Yangbing Jin, Dandan Ren, Zehui Zhang, Siyi Zou, Fanlu Li, Huaibo Sun, Jiabin Jin, Xiongxiong Lu, Junjie Xie, Dongfeng Cheng, Zhiwei Xu, Huan Chen, Beibei Mao, Jun Zhang, Jiancheng Wang, Xiaxing Deng, Chenghong Peng, Hongwei Li, Cen Jiang, Lin Lin, Henghui Zhang, Hao Chen, Baiyong Shen
Journal: International Journal of Surgery (2023)

Background: Patients with resected pancreatic adenocarcinoma (PAAD) often experience short-term relapse and dismal survival, suggesting an urgent need to develop predictive and/or prognostic biomarkers for these populations. Given the potential associations of human leukocyte antigen class I (HLA-I) genotype with oncogenic mutational profile and immunotherapy efficacy, we aimed to assess whether differential HLA-I genotype could predict the postoperative outcomes in resected PAAD patients. Materials and Methods: HLA-I (A, B and C) genotyping and somatic variants of 608 Chinese PAAD patients were determined by targeted next-generation sequencing of matched blood cells and tumor tissues. HLA-A/B alleles were classified with the available definition of 12 supertypes. Kaplan-Meier curves of disease-free survival (DFS) and multivariable Cox proportional-hazards regression analyses were performed to determine the survival difference in 226 selected patients with radical resection. Early-stage (I-II) patients constituted the majority (82%, 185/226) and some stage I-II individuals with high-quality tumor samples were analyzed by RNA-sequencing to examine immunophenotypes. Results: Patients with HLA-A02+B62+B44- had significantly shorter DFS (median, 239 vs. 410 d; hazard ratio [HR]=1.65, P=0.0189) than patients without this genotype. Notably, stage I-II patients carrying HLA-A02+B62+B44- had sharply shorter DFS than those without HLA-A02+B62+B44- (median, 237 vs. 427 d; HR=1.85, P=0.007). Multivariate analyses revealed that HLA-A02+B62+B44- was associated with significantly inferior DFS (P=0.014) in stage I-II patients but not in stage III patients. Mechanistically, HLA-A02+B62+B44- patients were associated with a high rate of KRAS G12D & TP53 mutations, lower HLA-A expression, and less inflamed T-cell infiltration. Conclusions: The current results suggest that a specific combination of germline HLA-A02/B62/B44 supertype, HLA-A02+B62+B44-, was a potential predictor for DFS in early-stage PAAD patients after surgery. Export
Epithelium‐derived cystatin SN inhibits house dust mite protease activity in allergic asthma
Authors: Lei Yao, Xijing Yuan, Heng Fu, Qinxing Guo, Yunhui Wu, Shurui Xuan, Nazanin Zounemat Kermani, Ian M. Adcock, Xiaoning Zeng, Yi Liu, Min Xie, Xin Yao
Journal: Allergy (2023)

Abstract Background Allergen source‐derived proteases are a critical factor in the formation and development of asthma. The cysteine protease activity of house dust mite (HDM) disrupts the epithelial barrier function. The expression of cystatin SN (CST1) is elevated in asthma epithelium. CST1 inhibits the cysteine protease activity. We aimed to elucidate the role of epithelium‐derived CST1 in the development of asthma caused by HDM. Methods CST1 protein levels in sputum supernatants and serum of patients with asthma and healthy volunteers were measured by ELISA. The ability of CST1 protein to suppress HDM‐induced bronchial epithelial barrier function was examined in vitro. The effects of exogenous CST1 protein on abrogating HDM‐induced epithelial barrier function and inflammation were examined in mice in vivo. Results CST1 protein levels were higher in sputum supernatants (142.4 ± 8.95 vs 38.87 ± 6.85 ng/mL, P &lt; 0.0001) and serum (1129 ± 73.82 vs 703.1 ± 57.02 pg/mL, P = 0.0035) in patients with asthma than in healthy subjects. The levels were significantly higher in patients with not well‐ and very poorly controlled asthma than those with well‐controlled asthma. Sputum and serum CST1 protein levels were negatively correlated with lung function in asthma. CST1 protein levels were significantly lower in the serum of HDM‐specific IgE (sIgE)‐positive asthmatics than in sIgE‐negative asthmatics. The HDM‐induced epithelial barrier function disruption was suppressed by recombinant human CST1 protein (rhCST1) in vitro and in vivo. Conclusion Our data indicated that human CST1 protein suppresses asthma symptoms by protecting the asthmatic bronchial epithelial barrier through inhibiting allergenic protease activity. CST1 protein may serve as a potential biomarker for asthma control.
Posttraumatic Stress Symptom Trajectories in Family Caregivers of Patients With Acute Cardiorespiratory Failure
Authors: Blair Wendlandt, Liam Pongracz, Feng-Chang Lin, Mark Toles, Bradley N. Gaynes, Laura C. Hanson, Shannon S. Carson
Journal: JAMA Network Open (2023)

Overall, 1 in 3 family caregivers of patients who require intensive care unit (ICU) admission will experience significant posttraumatic stress symptoms (PTSSs), but little is known about how PTSSs evolve over time. Measuring PTSS trajectories could facilitate the development of targeted interventions to improve mental health outcomes for family caregivers of critically ill patients.To measure 6-month PTSS trajectories among caregivers of patients with acute cardiorespiratory failure.This prospective cohort study was conducted in the medical ICU of a large academic medical center among adult patients requiring (1) vasopressors for shock, (2) high-flow nasal cannula, (3) noninvasive positive pressure ventilation, or (4) invasive mechanical ventilation. Each patient was enrolled along with their primary caregiver, ie, the unpaid individual who provided the most physical, emotional, or financial support prior to ICU admission.Family caregiver PTSSs were assessed using the Impact of Events Scale-Revised within 48 hours of ICU admission, following ICU discharge, and 3 and 6 months after enrollment. Latent class growth analysis was used to measure PTSS trajectories. Preselected patient and caregiver characteristics measured at ICU admission were analyzed for association with trajectory membership. Six-month patient and caregiver outcomes were analyzed by caregiver trajectory.Overall, 95 family caregivers were enrolled and provided baseline data; mean (SD) age was 54.2 (13.6) years, 72 (76%) were women, 22 (23%) were Black individuals, and 70 (74%) were White individuals. Three trajectories were identified: persistently low (51 caregivers [54%]), resolving (29 [31%]), and chronic (15 [16%]). Low caregiver resilience, prior caregiver trauma, high patient severity of illness, and good patient premorbid functional status were associated with the chronic trajectory. Caregivers with the chronic PTSS trajectory had worse 6-month health-related quality of life (mean [SD] total 36-item Short Form Survey score, persistently low trajectory: 104.7 [11.3]; resolving trajectory: 101.7 [10.4]; chronic trajectory: 84.0 [14.4]; P < .001) and reduced effectiveness at work (mean [SD] perceived effectiveness at work score, persistently low trajectory: 86.0 [24.2]; resolving trajectory: 59.1 [32.7]; chronic trajectory: 72.3 [18.4]; P = .009).In this study, 3 distinct PTSS trajectories among ICU family caregivers were observed, with 16% of caregivers experiencing chronic PTSSs over the subsequent 6 months. Family caregivers with persistent PTSS had lower resilience, prior trauma, higher patient severity of illness, and higher baseline patient functional status compared with family caregivers with persistently low PTSS, with adverse effects on quality of life and work. Identifying these caregivers is an essential first step to develop interventions tailored to those with the greatest need for support.
Severe Maternal Morbidity and Mortality of Pregnant Patients With COVID-19 Infection During the Early Pandemic Period in the US
Authors: Koji Matsuo, Jessica M. Green, Sarah A. Herrman, Rachel S. Mandelbaum, Joseph G. Ouzounian
Journal: JAMA Network Open (2023)

This cohort study examines the patient characteristics and maternal outcomes associated with COVID-19 infection among pregnant patients at delivery during the early pandemic period in the US.
Amniogenesis in Human Amniotic Sac Embryoids after Exposures to Organophosphate Flame Retardants
Authors: Chenke Xu, Chenhao Zhang, Yanan Liu, Haojia Ma, Feifan Wu, Yingting Jia, Jianying Hu
Journal: Environmental Health Perspectives (2023)

Background: Amniogenesis is a key event in biochemical pregnancy, and its failure may result in human embryonic death. However, whether and how environmental chemicals affect amniogenesis remain largely unknown. Objectives: The objective of the present study was to screen chemicals that may disrupt amniogenesis in an amniotic sac embryoid model and to investigate the potential mechanism of amniogenesis failure, with a focus on organophosphate flame retardants (OPFRs). Methods: This study developed a high-throughput toxicity screening assay based on transcriptional activity of octamer-binding transcription factor 4 (Oct4). For the two positive OPFR hits with the strongest inhibitory activity, we used time-lapse and phase-contrast imaging to assess their effects on amniogenesis. Associated pathways were explored by RNA-sequencing and western blotting, and potential binding target protein was identified through a competitive binding experiment. Results: Eight positive hits exhibiting Oct4 expression were identified, with 2-ethylhexyl-diphenyl phosphate (EHDPP) and isodecyl diphenyl phosphate (IDDPP) showing the strongest inhibitory activity. EHDPP and IDDPP were found to disrupt the rosette-like structure of the amniotic sac or inhibit its development. Functional markers of squamous amniotic ectoderm and inner cell mass were also found disrupted in the EHDPP- and IDDPP-exposed embryoids. Mechanistically, embryoids exposed to each chemical exhibited abnormal accumulation of phosphorylated nonmuscle myosin (p-MLC-II) and were able to bind to integrin β1 (ITGβ1). Conclusion: The amniotic sac embryoid models suggested that OPFRs disrupted amniogenesis likely by inhibiting the ITGβ1 pathway, thus providing direct in vitro evidence associating OPFRs with biochemical miscarriage. https://doi.org/10.1289/EHP11958
Management of leaks following one-anastomosis gastric bypass: an updated systematic review and meta-analysis of 44 318 patients
Authors: Mohammad Kermansaravi, Radwan Kassir, Rohollah Valizadeh, Chetan Parmar, Amir Hossein Davarpanah Jazi, Shahab Shahabi Shahmiri, Marine Benois
Journal: International Journal of Surgery (2023)

One-anastomosis gastric bypass (OAGB) complication, such as leakage, can be dangerous and should be managed properly, yet little data exist in the literature regarding the management of leaks after OAGB, and there are no guidelines to date.The authors performed a systematic review and meta-analysis of the literature and 46 studies, examining 44 318 patients were included.There were 410 leaks reported in 44 318 patients of OAGB published in the literature, which represents a prevalence of 1% of leaks after OAGB. The surgical strategy was very variable among all the different studies; 62.1% of patients with leaks had to undergo another surgery due to the leak. The most commonly performed procedure was peritoneal washout and drainage (with or without T-tube placement) in 30.8% of patients, followed by conversion to Roux-en-Y gastric bypass in 9.6% of patients. Medical treatment with antibiotics, with or without total parenteral nutrition alone, was conducted in 13.6% of patients. Among the patients with the leak, the mortality rate related to the leak was 1.95%, and the mortality due to the leak in the population of OAGB was 0.02%.The management of leaks following OAGB requires a multidisciplinary approach. OAGB is a safe operation with a low leak risk rate, and the leaks can be managed successfully if detected in a timely fashion.
Calling for continuous surgical support in Ukraine
Authors: Andrew A. Wireko, Jyi Cheng Ng, Lian David, Toufik Abdul-Rahman, Vladyslav Sikora, Arda Isik
Journal: International Journal of Surgery (2023)

Wireko, Andrew A. MBBS; Ng, Jyi Cheng MD; David, Lian MBBS; Abdul-Rahman, Toufik MBBS; Sikora, Vladyslav MD, PhD; Isik, Arda FEBS, FACS, MD Author Information
Evidence-based objective performance criteria for the evaluation of hip and knee replacement devices and technologies
Authors: Marc J. Nieuwenhuijse, Per-Henrik Randsborg, Jensen H. Hyde, Wenna Xi, Patricia Franklin, Limin Sun, Xinyan Zheng, Samprit Banerjee, Jialin Mao, Suvekshya Aryal, Priscilla Chan, Amanda Chen, Alexander Liebeskind, Pablo Bonangelino, Paul Voorhorst, Laura E. Gressler, Vincent Devlin, Raquel Peat, Danica Marinac-Dabic, Elizabeth Paxton, Art Sedrakyan
Journal: International Journal of Surgery (2023)

Background: Objective performance criteria (OPC) is a novel method to provide minimum performance standards and improve the regulated introduction of original or incremental device innovations in order to prevent patients from being exposed to potentially inferior designs whilst allowing timely access to improvements. We developed 2-year safety and effectiveness OPC for total hip and knee replacement (THR and TKR). Methods: Analyses of large databases were conducted using various data sources: a systematic literature review; a direct data analysis from The Functional Outcomes Research for Comparative Effectiveness in Total Joint Replacement and Quality Improvement Registry (FORCE-TJR) and the Kaiser Permanente Implant Registry (KPIR); and claims data analyses from longitudinal discharge data in New York and California states. The literature review included U.S. patients (≥18 years) who received THR or TKR for primary end-stage osteoarthritis and prospectively collected data on patient-reported outcome measures (PROMs) from at least 100 subjects and/or 2-year implant survival for at least 250 implants. Random effects models were used for meta-analysis. Results: Data were available from a total of 951 100 patients. After screening of 7979 abstracts, 294 studies underwent full-text review and 31 studies contributed to the evidence synthesis (333 995 implants). Direct data analysis of FORCE-TJR contributed 9223 joint replacement patients to the construction of OPC for effectiveness; KPIR contributed 262 044 patients for the construction of OPC for safety. Claims database analysis contributed 345 838 patients to the construction of safety OPC. OPC for safety were constructed for cumulative incidences of 2-year all-cause and septic revision (THR/TKR 2.0%/1.6% and 0.6%/0.7%), and OPC for effectiveness were constructed based on four disease-specific and three general health-related quality of life PROMs (HOOS/KOOS 87.1/80.6; HSS/KSS function 94.4/90.6; SF-12/SF-36, PCS 46.5/41.9, EQ-5D 0.88/0.84). Conclusion: This study is the first to construct a 2-year OPC for the safety and effectiveness of THR and TKR based on U.S. real-world data. Based on these OPC, potential benchmarks for (single-arm study) evaluation of new device innovations are suggested for a regulated and safe introduction to the (commercial) market.
Factors affecting the quality of laparoscopic D2 lymph node dissection for gastric cancer: a cohort study from two randomized controlled trials
Authors: Jun Lu, Jiao-Bao Huang, Dong Wu, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Chao-Hui Zheng, Chang-Ming Huang, Ping Li
Journal: International Journal of Surgery (2023)

Laparoscopic D2 lymph node dissection (LND) for gastric cancer has a wide range and high difficulty. In the past, the quality of surgery was often judged by the time of the operation or the amount of blood loss, but the analysis based on surgical video was rarely reported. The purpose of this study was to analyze the relationship between the quality of laparoscopic D2 LND for gastric cancer and postoperative complications.The surgical video and clinicopathological data of 610 patients in two randomized controlled trials in our center from 2013 to 2016 were retrospectively analyzed. Klass-02-QC LND scale and general error score tool were used to quantitatively evaluate the intraoperative performance of D2 LND. Logistic regression was used to analyze the influencing factors of postoperative complications.The overall incidence of complications (CD classification≥2) was 20.6%; the incidence of surgical complications was 6.9%. According to whether the LND score reached 44, patients were divided into a qualified group (73%) and a not-qualified group (27%). Event score (ES) by quartile was divided into grade 1 (21.7%), grade 2 (26%), grade 3 (28%), and grade 4 (24.3%) from low to high. Univariate logistic regression analysis showed that ES greater than or equal to 3, tumor size greater than or equal to 35 mm, and cTNM >II were independent risk factors for not-qualified LND. Male,tumor size greater than or equal to 35 mm and cTNM >II were independent risk factors for grade 4 ES. Not-qualified LND (OR=1.62, 95% CI: 1.16-3.89, P =0.021), grade 4 ES (OR=3.21, 95% CI: 1.52-3.90, P =0.035), and cTNM >II (OR=1.74, 95% CI: 1.39-7.33, P =0.041) were independent risk factors for postoperative surgical complications.The qualification of LND and intraoperative events based on surgical video are the independent influencing factors of postoperative complications of laparoscopic gastric cancer surgery. Specialist training and teaching based on surgical video may help to improve the surgical skills of specialists and improve the postoperative outcome of patients.
Exploring objective factors to predict successful outcomes after laparoscopic Nissen fundoplication
Authors: Sangjun Park, Shin-Hoo Park, Min Seo Kim, Jisoo Kwak, Inhyeok Lee, Yeongkeun Kwon, Chang Min Lee, Hyuk Soon Choi, Bora Keum, Kyung-Sook Yang, Joong-Min Park, Sungsoo Park
Journal: International Journal of Surgery (2023)

Currently, the reported parameters that predict the resolution of symptoms after surgery are largely subjective and unreliable. Considering that fundoplication rebuilds the structural integrity of the lower esophageal sphincter (LES), the authors focused on searching for objective and quantitative predictors for the resolution of symptoms based on the anatomical issues and whether an antireflux barrier can be well established or not.The authors reviewed the prospectively collected data of 266 patients with gastroesophageal reflux disease (GERD) who had undergone laparoscopic Nissen fundoplication (LNF). All patients were diagnosed with GERD using preoperative esophagogastroduodenoscopy, 24-h ambulatory esophageal pH monitoring, and high-resolution esophageal manometry. The patients received GERD symptom surveys using the validated Korean Antireflux Surgery Group questionnaire twice: preoperatively and 3 months after the surgery.After excluding patients with insufficient follow-up data, 152 patients were included in the analysis. Multivariate logistic regression analyses revealed that a longer length of the LES and lower BMI determined better resolution of typical symptoms after LNF (all P <0.05). Regarding atypical symptoms, higher resting pressure of LES and DeMeester score greater than or equal to 14.7 were associated with better resolution after the surgery (all P <0.05). After LNF, typical symptoms improved in 34 out of 37 patients (91.9%) with a length of LES >greater than .05 cm, BMI less than 23.67 kg/m 2 , and atypical symptoms were resolved in 16 out of 19 patients (84.2%) with resting pressure of LES greater than or equal to 19.65 mm Hg, DeMeester score greater than or equal to 14.7.These results show that the preoperative length and resting pressure of LES is important in the objective prediction of symptom improvement after LNF.
Neuroblastoma: Emerging trends in pathogenesis, diagnosis, and therapeutic targets
Authors: Santharam S. Katta, Veerababu Nagati, Atreya S.V. Paturi, Swati P. Murakonda, Ajay B. Murakonda, Manoj K. Pandey, Subash C. Gupta, Anil K. Pasupulati, Kishore B. Challagundla
Journal: Journal of Controlled Release (2023)
Multifaceted Roles of Copper Ions in Anticancer Nanomedicine
Authors: Siyuan Yang, Yingnan Song, Yanling Hu, HongJin Chen, Dongliang Yang, Xuejiao Song
Journal: Advanced Healthcare Materials (2023)

Abstract The significantly increased copper level in tumor tissues and serum indicates the close association of copper ions with tumor development, making copper ions attractive targets in the development of novel tumor treatment methods. The advanced nanotechnology developed in the past decades provides great potential for tumor therapy, among which Cu‐based nanotherapeutic systems have received greater attention. Herein, the multifaceted roles of copper ions in cancer progression are summarized and the recent advances in the copper‐based nanostructures or nanomedicines for different kinds of tumor therapies including copper depletion therapy, copper‐based cytotoxins, copper‐ion‐based chemodynamic therapy and its combination with other treatments, and copper‐ion‐induced ferroptosis and cuproptosis activation are discussed. Furthermore, the perspectives for the further development of copper‐ion‐based nanomedicines for tumor therapy and clinic translation are presented by the authors.